This invention relates to a medical surgical procedure. More particularly, this invention relates to a minimally invasive surgical method. This invention also relates to a surgical port device and instrument kit for use in carrying out the method.
U.S. Pat. Nos. 5,297,536 and 5,458,131 disclose a minimally invasive method for intra-abdominal surgical procedures that avoids the formation of an incision in the patient's skin surface. As described in those patents, a method for use in intra-abdominal surgery comprises the steps of (a) inserting an incising instrument with an elongate shaft through a natural body opening into a natural body cavity of a patient, (b) manipulating the incising instrument from outside the patient to form a perforation in an internal wall of the natural internal body cavity, and (c) inserting a distal end of an elongate surgical instrument through the natural body opening, the natural body cavity and the perforation into an abdominal cavity of the patient upon formation of the perforation. Further steps of the method include (d) inserting a distal end of an endoscope into the abdominal cavity, (e) operating the surgical instrument to perform a surgical operation on an organ in the abdominal cavity, (f) viewing the surgical operation via the endoscope, (g) withdrawing the surgical instrument and the endoscope from the abdominal cavity upon completion of the surgical operation, and (h) closing the perforation.
Visual feedback may be obtained as to position of a distal end of the incising instrument prior to the manipulating thereof to form the perforation. That visual feedback may be obtained via the endoscope or, alternatively, via radiographic or X-ray equipment.
The abdominal cavity may be insufflated prior to the insertion of the distal end of the endoscope into the abdominal cavity. Insufflation may be implemented via a Veress needle inserted through the abdominal wall or through another perforation in the internal wall of the natural body cavity. That other perforation is formed by the Veress needle itself. U.S. Pat. No. 5,209,721 discloses a Veress needle that utilizes ultrasound to detect the presence of an organ along an inner surface of the abdominal wall.
A method in accordance with the disclosures of U.S. Pat. Nos. 5,297,536 and 5,458,131 comprises the steps of (i) inserting an endoscope through a natural body opening into a natural body cavity of a patient, (ii) inserting an endoscopic type incising instrument through the natural body opening into the natural body cavity, (iii) manipulating the incising instrument from outside the patient to form a perforation in an internal wall of the natural internal body cavity, (iv) moving a distal end of the endoscope through the perforation, (v) using the endoscope to visually inspect internal body tissues in an abdominal cavity of the patient, (vi) inserting a distal end of an elongate surgical instrument into the abdominal cavity of the patient, (vii) executing a surgical operation on the internal body tissues by manipulating the surgical instrument from outside the patient, (viii) upon completion of the surgical operation, withdrawing the surgical instrument and the endoscope from the abdominal cavity, (ix) closing the perforation, and (x) withdrawing the endoscope from the natural body cavity.
The surgical procedures of U.S. Pat. Nos. 5,297,536 and 5,458,131 reduce trauma to the individual even more than laparoscopic procedures. Hospital convalescence stays are even shorter. There are some potential problems with the procedures, such as the difficulty in forming a fluid tight closure of the perforation formed in the wall of the hollow internal body organ. Certain intra-abdominal operations cannot be easily performed owing to the necessity or removing large chunks of organic or inorganic material (e.g., entire kidney, gall stones). Some operations can require the simultaneous usage of many different instruments so that space along the selected pathways may be difficult to find.
U.S. Pat. No. 5,273,051 describes a minimally invasive method that provides access to abdominal organs via the vascular system, for purposes obtaining a biopsy of an internal organ. The method of that patent more particularly comprises the steps of (a) providing a biopsy device including a flexible elongate tubular member and a biopsy-taking component at a distal end of the tubular member for obtaining a tissue sample, (b) forming an incision in a blood vessel of a vascular system of the patient, (c) inserting a distal end portion of the biopsy device through the incision into the blood vessel, (d) manipulating the biopsy device to maneuver the distal end portion through the vascular system to the internal organ, (e) piercing a blood vessel wall with a sharp distal tip of the biopsy device upon arrival of the biopsy-taking component at the internal organ, (f) pushing the biopsy device so that the biopsy-taking component enters the internal organ, (g) operating the biopsy-taking component to capture a sample of tissues of the internal organ, and (h) withdrawing the biopsy device with the captured tissue sample from the vascular system of the patient through the blood vessel and the incision.